A 20-year-old who has been in the sun for six hours on a hot day presents with dizziness, weakness, thirst, nausea; orthostatic changes are noted. What should the paramedic initiate?

A 20-year-old who has been in the sun for six hours on a hot day presents with dizziness, weakness, thirst, nausea; orthostatic changes are noted. What should the paramedic initiate?

• A. Give 32 ounces of electrolyte solution orally
• B. Transport patient as quickly as possible
• C. IV NS in consecutive 200 mL increments
• D. Cover with a cold wet sheet

Answer: (C)

The situation points to dehydration with significant loss of circulating volume (hypovolemia) from prolonged heat exposure. The priority is to restore intravascular volume so the patient’s blood pressure and perfusion improve, rather than focusing on cooling or oral fluids alone. Starting an IV with normal saline and delivering it in small, repeatable boluses (about 200 mL at a time) is the best approach because isotonic fluid stays in the vascular space and quickly expands circulating volume. The 200 mL increments allow you to judge the patient’s response—improving dizziness, orthostatic symptoms, and blood pressure—without risking fluid overload. Once perfusion improves, you can continue rehydration and monitor for signs of heat-related illness. Oral electrolyte solution could be appropriate if the patient can drink and is not vomiting or profoundly hypotensive, but the presence of orthostatic changes indicates more significant dehydration that often benefits from IV rehydration for faster, controlled correction. Cooling measures are important for heat illness, but they don’t address the underlying hypovolemia this scenario presents.

The situation points to dehydration with significant loss of circulating volume (hypovolemia) from prolonged heat exposure. The priority is to restore intravascular volume so the patient’s blood pressure and perfusion improve, rather than focusing on cooling or oral fluids alone.

Starting an IV with normal saline and delivering it in small, repeatable boluses (about 200 mL at a time) is the best approach because isotonic fluid stays in the vascular space and quickly expands circulating volume. The 200 mL increments allow you to judge the patient’s response—improving dizziness, orthostatic symptoms, and blood pressure—without risking fluid overload. Once perfusion improves, you can continue rehydration and monitor for signs of heat-related illness.

Oral electrolyte solution could be appropriate if the patient can drink and is not vomiting or profoundly hypotensive, but the presence of orthostatic changes indicates more significant dehydration that often benefits from IV rehydration for faster, controlled correction. Cooling measures are important for heat illness, but they don’t address the underlying hypovolemia this scenario presents.